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aMAP Score and Its Combination With Liver Stiffness Measurement Accurately Assess Liver Fibrosis in Chronic Hepatitis
Rong Fan1, Guanlin Li2, Ning Yu1
1Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Guangdong Provincial Clinical Research Center for Viral Hepatitis, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Background & Aims:
The changes in liver stiffness measurement (LSM) are unreliable to estimate regression of fibrosis during antiviral treatment for chronic hepatitis B (CHB) patients. The age-male-albumin-bilirubin-platelets score (aMAP), as an accurate hepatocellular carcinoma risk score, may reflect the liver fibrosis stage. Here, we aimed to evaluate the performance of aMAP for diagnosing liver fibrosis in CHB patients with or without treatment.
Methods:
A total of 2053 patients from 2 real-world cohorts and 2 multicentric randomized controlled trials in China were enrolled, among which 2053 CHB patients were included in the cross-sectional analysis, and 889 CHB patients with paired liver biopsies before and after 72 or 104 weeks of treatment were included in the longitudinal analysis.
Results:
In the cross-sectional analysis, the areas under the receiver operating characteristic curve of aMAP in diagnosing cirrhosis and advanced fibrosis were 0.788 and 0.757, which were comparable with or significantly higher than those of the fibrosis index based on 4 factors and the aspartate aminotransferase-platelet ratio. The stepwise approach using aMAP and LSM further improved performance in detecting cirrhosis and advanced fibrosis with the smallest uncertainty area (29.7% and 46.2%, respectively) and high accuracy (82.3% and 79.8%, respectively). In the longitudinal analysis, we established a novel model (aMAP-LSM model) by calculating aMAP and LSM results before and after treatment, which had satisfactory performance in diagnosing cirrhosis and advanced fibrosis after treatment (area under the receiver operating characteristic curve, 0.839 and 0.840, respectively), especially for those with a significant decrease in LSM after treatment (vs LSM alone, 0.828 vs 0.748; P < .001 [cirrhosis]; 0.825 vs 0.750; P < .001 [advanced fibrosis]).
Conclusions:
The aMAP score is a promising noninvasive tool for diagnosing fibrosis in CHB patients. The aMAP-LSM model could accurately estimate fibrosis stage for treated CHB patients.
Insights
The age-male-albumin-bilirubin-platelets (aMAP) score shows promise for diagnosing liver fibrosis in chronic hepatitis B (CHB) patients. A new aMAP-LSM model accurately assesses fibrosis stage, especially after treatment.
Area of Science:
- Hepatology
- Gastroenterology
- Medical Diagnostics
Background:
- Liver stiffness measurement (LSM) is unreliable for tracking fibrosis regression in treated chronic hepatitis B (CHB) patients.
- The age-male-albumin-bilirubin-platelets (aMAP) score, a known hepatocellular carcinoma risk predictor, may indicate liver fibrosis.
- Accurate noninvasive methods are needed to assess liver fibrosis in CHB patients, both treated and untreated.
Purpose of the Study:
- To evaluate the diagnostic performance of the aMAP score for liver fibrosis in CHB patients.
- To assess the utility of aMAP in conjunction with LSM for fibrosis staging.
- To develop and validate a novel model for estimating fibrosis stage in treated CHB patients.
Main Methods:
- Cross-sectional analysis of 2053 CHB patients from real-world and clinical trial data.
- Longitudinal analysis of 889 CHB patients with paired liver biopsies before and after antiviral treatment (72 or 104 weeks).
- Evaluation of aMAP score, LSM, and a combined aMAP-LSM model for diagnosing cirrhosis and advanced fibrosis.
Main Results:
- The aMAP score demonstrated good performance in diagnosing cirrhosis (AUC 0.788) and advanced fibrosis (AUC 0.757).
- Combining aMAP and LSM improved diagnostic accuracy and reduced uncertainty for cirrhosis (82.3%) and advanced fibrosis (79.8%).
- The novel aMAP-LSM model showed high accuracy in diagnosing fibrosis post-treatment (AUC 0.839 for cirrhosis, 0.840 for advanced fibrosis), outperforming LSM alone.
Conclusions:
- The aMAP score is a valuable noninvasive tool for diagnosing liver fibrosis in CHB patients.
- The aMAP-LSM model offers accurate fibrosis staging for treated CHB patients, particularly when LSM shows significant improvement.
- These findings support the use of aMAP-based approaches for noninvasive liver fibrosis assessment in CHB.
